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Paediatrics Flashcards

1
Q

At what age can a child sit without support?

A

6-8m (LA: 12m)

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2
Q

At what age will a child begin to walk?

A

12m (LA: 18m)

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3
Q

At what age can a child run?

A

2.5y

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4
Q

At what age can a child ride a tricycle?

A

3y

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5
Q

At what age can a child hop and skip?

A

4y and 5y respectively

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6
Q

At what age will a child follow a moving object by turning their head?

A

6w (LA: 3m)

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7
Q

At what age will a child reach out for a toy?

A

4m (LA: 6m)

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8
Q

At what age does a child develop a mature pincer grip?

A

10m (LA: 12m)

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9
Q

At what age can a child build a tower of 3 blocks?

A

18m

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10
Q

At what age can a child build a bridge of blocks?

A

3y

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11
Q

A what age can a child draw a line?

A

2y

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12
Q

A what age can a child draw a circle?

A

3y

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13
Q

A what age can a child draw a square?

A

4y

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14
Q

A what age can a child draw a triangle?

A

5y

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15
Q

At what age will a child start to use the words mama or dad?

A

7-10m

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16
Q

At what age can a child join words to make simple phrases?

A

20-24m

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17
Q

At what age can a child understand their name?

A

12m

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18
Q

At what age can a child smile reponsively?

A

6w (LA: 10w)

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19
Q

At what age can a child wave bye bye?

A

10-12m

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20
Q

At what age can a child drink from a cup?

A

12m

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21
Q

At what age can a child use a spoon?

A

18m

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22
Q

At what age will a child start to take turns when playing?

A

2.5-3y

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23
Q

How long is age corrected for prematurity when considering milestones?

A

2 years

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24
Q

What is the moro reflex?

A

Head extension causes abduction followed by adduction of the arms, till 3-4 months

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25
Q

What is the grasp reflex?

A

Flexion of fingers when object placed in palm, till 4-5 months

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26
Q

What is colic?

A

Paroxysmal crying with pulling up of legs for >3h on ≥3days/week.

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27
Q

What are some features of cow’s milk protein allergy?

A

Colic symptoms, GORD, blood/mucus in stools,

eczema, faltering growth

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28
Q

How should cow’s milk protein allergy be managed?

A

Exclude cow’s milk from mother diet or use extensive hydrolysed/amino acid formula

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29
Q

How does ammonia dermatitis (nappy rash) present?

A

Red desquamating rash, sparing skin folds, due to

moisture retention

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30
Q

How should ammonia dermatitis (nappy rash) be treated?

A

Frequent nappy changes, nappy free periods, careful drying and emollient creams

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31
Q

What can cause vomiting in infancy?

A

Regurg during feeds (posseting) or between feeds
GORD
Overfeeding (150ml/kg/day normal)
Pyloric stenosis – projectile, 6-10 weeks old
Infections
Adverse food reactions – allergies, coeliac

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32
Q

What can cause bilous vomiting in infancy?

A

Duodenal obstruction, volvulus

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33
Q

What are some lung complications of mechanical ventilation?

A

Pneumothorax
Pulmonary haemorrhage
Bronchopulmonary dysplasia
Pneumonia

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34
Q

What are some airway complications of mechanical ventilation?

A

Upper airway obstruction, GORD, laryngomalacia

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35
Q

What are some non-respiratory complications of mechanical ventilation?

A

PDA, RICP
Retinopathy of prematurity
Subcutaneous emphysema
Air in mediastinum, pericardium, peritoneum due to air leak (ruptured alveoli)

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36
Q

What is the definition for preterm?

A

<37 weeks

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37
Q

What is the defintion for low birth weight? Very low birth weight? Extremely low birth weight?

A

L: <2500g
VL: <1500g
EL: <1000g

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38
Q

What is symmetric IUGR? And what are some causes?

A

All growth parameters are symmetrically small suggesting fetus was affected from early pregnancy Chromosomal abnormalities and constitutionally small

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39
Q

What is asymmetric IUGR? And what is a cause?

A

Weight centile is less than length and head circumference

Pre-eclampsia

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40
Q

What is Hirschsprung’s disease?

A

Congenital absence of ganglia in a segment of colon leading to functional GI obstruction, constipation and
megacolon

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41
Q

How is Hirschsprung’s diagnosed?

A

Rectal suction biopsy of aganglionic section staining for

acetylcholinesterase positive nerve excess

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42
Q

How is Hirschsprung’s treated?

A

Bowel irrigation and surgery

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43
Q

What are some complications of Hirschsprung’s?

A

GI perforation, bleeding, ulcers, enterocolitis

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44
Q

What are some signs of oesophageal atresia + trachea-oesophageal fistula?

A 
Polyhydramnios
Cough
Airway obstruction
Increased secretions
Distended abdo
Cyanosis
Aspiration
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45
Q

How should oesophageal atresia + trachea-oesophageal fistula be treated?

A

Stopping feeding, suck out oesophageal pouch and surgery

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46
Q

Describe the features of congenital diaphragmatic hernia:

A

Developmental defect (left pos. diaphragm) allowing herniation of abdo contents into chest

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47
Q

What are some signs of congenital diaphragmatic hernia?

A

Respiratory distress, bowel sounds over hemithorax, cyanosis

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48
Q

How should congenital diaphragmatic hernia be treated?

A

Large bore NGT to remove air from gut and then surgery

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49
Q

What are some complications of inguinal hernia?

A

Obstruction, incarceration, strangulation

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50
Q

When should an inguinal hernia be operated on in a baby <6w, child <6m and child <6y?

A

Within 2d
Within 2w
Within 2m

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51
Q

What is Meckel’s diverticulum?

A

Remnant of the omphalomesenteric duct in small intestine and contains ectopic ileal, gastric or pancreatic mucosa

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52
Q

How can Meckel’s diverticulum present?

A

Asymptomatic, abdo pain, rectal bleeding, intestinal obstruction

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53
Q

What is gastroschisis?

A

Paraumbilical defect with extrusion of viscera and abdo contents with no covering

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54
Q

What is the management for gastroschisis?

A

Cover exposed bowel in clingfilm, keep baby warm and hydrated and close defect ASAP

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55
Q

What is exomphalos?

A

Ventral defects of umbilical ring with herniation of abdo viscera covered in peritoneum

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56
Q

What are the consequences of congenital diaphragmatic hernia?

A

Leads to impaired lung development (hypoplasia and pulmonary HTN)

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57
Q

How should undescended testis be managed?

A

Orchidopexy

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58
Q

What can cause oligohydramnios prenatally and absent/feeble voiding postnatally?

A

Posterior urethral valves

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59
Q

What is hypospadias?

A

Abnormal position of external urethral meatus on ventral penis

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60
Q

How should hypospadias be managed?

A

Use foreskin for preschool repair

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61
Q

What is patent urachus?

A

Opening between bladder and navel, urine leaks from umbilicus

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62
Q

What is bladder exstrophy?

A

Extrusion of bladder through defect in abdo wall

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63
Q

What is the commonest renal tumour in children?

A

Wilms’ nephroblastoma

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64
Q

How can Wilms’ nephroblastoma present?

A

Before 4yrs with painless, palpable abdo mass

Fever, flank pain

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65
Q

What is the management for Wilms’ nephroblastoma?

A

Nephrectomy with neo-adjuvant chemo

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66
Q

What is the pathophysiology of congenital adrenal hyperplasia?

A

Deficiency of 21-hydroxylase.
Cortisol not produced so rise of ACTH, adrenal hyperplasia and overproduction of androgenic cortisol precursors leading to increased testosterone

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67
Q

What are some signs of congenital adrenal hyperplasia?

A

Vomiting, dehydration, ambiguous genitalia
Boys may have precocious puberty or incomplete masculinisation
Growth and fertility impairment

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68
Q

What is the management for congenital adrenal hyperplasia?

A

Glucocorticoid replacement in all, mineralocorticoid replacement if salt-wasting

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69
Q

What are some signs of an adrenal crisis?

A

N+V, abdo pain, lethargy, hypotension

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70
Q

What is the management for an adrenal crisis?

A

Hydrocortisone IV, saline IVI, glucose, fludrocortisone

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71
Q

What are some causes of cleft lip and palate?

A

Genes, benzodiazepines, antiepileptics, rubella

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72
Q

How can cleft lip and palate be managed?

A

Feeding with special teats
Plastic surgery (lip at 3 months, palate at 6)
Speech therapy

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73
Q

What is spina bifida? What are the 3 types?

A

Incomplete closing of spine and meninges during development

3 types: spina bifida occulta, meningocele, myelomeningocele

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74
Q

What is meningocele? What is myelomeningocele?

A

Herniation of dura and arachnoid mater through bony defect

If involving cord, myelomeningocele

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75
Q

How can neural tube defects be prevented?

A

0.4mg folic acid daily from 3 months preconception to 13 weeks gestation
If high risk, 5mg

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76
Q

What are some features seen in fetal alcohol syndrome?

A 
Short palpebral fissure
Hypoplastic upper lip
Smooth/absent philtrum
Learning difficulties
Microcephaly
Growth retardation
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77
Q

What is Eisenmenger’s syndrome?

A

Increased pulmonary resistance causes reversal of left to right flow through shunt

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78
Q

How can ASD and VSD be managed?

A

Small defects can close spontaneously

Larger may need patch surgery

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79
Q

Describe some features you may elicit if a pt has a PDA:

A

Continuous machine murmur below left clavicle, collapsing pulse

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80
Q

How should PDA be managed?

A

Ensure no duct dependent circulation by echo

Treat with oral or IV ibuprofen

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81
Q

What are some features of coarctation of the aorta?

A

HTN, radio-femoral delay, ejection systolic murmur at ULSE

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82
Q

How should coarctation of the aorta be managed?

A

Stent or surgery by 5 years

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83
Q

How should TGA be managed?

A

Maintain PDA, balloon catheter atrial septal perforation, surgery with arterial switch

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84
Q

What are the defects in tetralogy of Fallot?

A

Large VSD, overriding aorta, pulmonary stenosis, RVH

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85
Q

What can cause innocent murmurs in children?

A

Fever, anxiety, exercise

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86
Q

Describe the classification of murmurs:

A
  1. Just audible
  2. Quiet but easily audible
  3. Loud, no thrill
  4. Loud with thrill
  5. Audible even if stethoscope makes partial contact with skin
  6. Audible without stethoscope
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87
Q

What are the steps in the management of cyanotic spells?

A 
Place child in knee to chest position
O2 through non-rebreather
Morphine
Fluid bolus
Propanolol, adrenaline
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88
Q

What are some of the main causes of HTN in children?

A

Renal parenchymal disease (80%)

Renal vascular disease, COA, endocrine, essential HTN

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89
Q

What are some investigations that should be performed in a child has HTN?

A 
Urine for albumin and blood
U+Es, creatinine, FBC
Renal US
Fasting lipids, glucose
ECG, echo
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90
Q

What are some signs of infective endocarditis?

A

Fever, splenomegaly, clubbing, splinter haemorrhages, anaemia, rash, HF, microscopic haematuria, new murmur

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91
Q

What are the main causative organisms of infective endoccarditis?

A

Streps, staphs

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92
Q

What investigations should be done if infective endocarditis is suspected?

A

Blood cultures (different times, different sites), echo

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93
Q

What treatment should be given for infective endocarditis?

A

Benpen + gentamicin

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94
Q

What is rheumatic fever?

A

Systemic febrile illness caused by a cross-sensitivity reaction to group A betahaemolytic strep and may result in permanent heart valve damage

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95
Q

What diagnostic criteria is used in rheumatic fever?

A

Jones diagnostic criteria

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96
Q

What are is the management of rheumatic fever?

A

Rest, aspirin, prednisolone and penicillin (pharyngitis)

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97
Q

What are the features of Kawasaki disease?

A 
Conjunctivitis
Rash
Adenopathy (cervical LNs)
Strawberry tongue
Hands (palmar erythema)
And Burn (fever for >5 days)
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98
Q

How should Kawasaki disease be treated?

A

High-dose aspirin, IV immunoglobulin, echo (screening test for coronary artery aneurysms)

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99
Q

What are the main causes of stridor?

A

Viral croup, bacterial tracheitis, epiglottitis, foreign body, laryngomalacia

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100
Q

What are the signs of croup?

A

Stridor, barking cough, hoarseness

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101
Q

What are the main causative organisms of croup?

A 
Parainfluenza virus (1, 2, 3)
Respiratory syncytial virus, measles
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102
Q

What is the management for mild croup?

A

Sent home if settles with dexamethasone

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103
Q

What is the management for severe croup?

A

Nebulised adrenaline and high flow O2, and if fails take to ITU

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104
Q

How can croup and bacterial tracheitis be differentiated?

A

Bacterial tracheitis often affects those >6y
Continuous stridor as opposed to stridor when upset
High fever in BT

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105
Q

What is the main causative organism in epiglottitis?

A

Haemophilus influenzae B

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106
Q

What is the management for epiglottitis?

A

Take child to theatre for inhalation induction of anaesthesia and EUA if necessary
Cefotaxime

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107
Q

What are some features of epiglottitis?

A

Sudden onset, continuous stridor, drooling of secretions, fever, cough not prominent

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108
Q

What are some symptoms of tonsillitis?

A

Pain on swallowing, fever, tonsillar exudate, cough, earache

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109
Q

How should need for antibiotics in tonsillitis be decided?

A

Centor or FeverPAIN

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110
Q

If needed, how long should antibiotics be given for in tonsillitis?

A

10d

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111
Q

What are some symptoms of otitis media?

A

Otalgia, irritability, decreased hearing, poor feeding, fever
Bulging, erythematous tympanic membrane

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112
Q

What are some causes of snoring in children?

A

Obesity, nasal polyps, deviated septum, recurrent tonsillitis, Down’s, hypothyroidism

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113
Q

What are some features of acute bronchiolitis?

A

Coryza, cough, fever, tachypnoea, wheeze, inspiratory crackles, apnoea, intercostal recession

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114
Q

What are the main causative organisms of acute bronchiolitis?

A

RSV

Mycoplasma, parainfluenza, adenovirus

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115
Q

What signs of acute bronchiolitis mean the child may need admitting?

A

Inadequate feeding, resp distress (grunting, recessions), hypoxia, cyanosis

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116
Q

What is the management for acute bronchiolitis?

A

O2 (stop when 92%)
Nasogastric feeds
May need CPAP

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117
Q

What are some features of pneumonia?

A

Fever, malaise, poor feeding, tachypnoea, cyanosis, grunting, recessions, accessory muscles
Older children may get pleural pain, crackles, bronchial breathing

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118
Q

What are the main causative organisms of pneumonia?

A

Pneumococcus, mycoplasma, haemophilus, staph, TB, viral

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119
Q

What signs of pneumonia mean the child may need admitting?

A

O2 <92%, signs of resp distress

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120
Q

What investigations should be performed if pneumonia is suspected?

A

CXR, FBC, sputum culture

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121
Q

What is the management for pneumonia?

A

Abx - oral amoxicllin

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122
Q

What are some signs of TB in children?

A

Anorexia, low fever, failure to thrive, malaise, cough

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123
Q

What investigations should be performed if TB is suspected?

A

Tuberculin tests
Interferon gamma release assays
Culture and Ziehl-Neelsen stain of sputa (x3)
CXR

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124
Q

What is the causative organism of whooping cough?

A

Bordetella pertussis

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125
Q

What ages of children does whooping cough typically affect?

A

Infants and 2nd peak in those >14y

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126
Q

What are some signs of whopping cough?

A

Apnoea, bouts of coughing ending with vomiting, worse at night or after feeds

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127
Q

How long do symptoms typically last in whooping cough?

A

10-14 weeks

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128
Q

What investigations should be performed if whooping cough is suspected?

A

PCR via nasal swab, culture, FBC (absolute lymphocytosis)

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129
Q

What are some complications of whooping cough?

A

Petechiae, conjunctivital, retinal and CNS bleeds
Apnoea
Inguinal hernias

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130
Q

What are some management options for whooping cough?

A

Admit if <6 months, may need ventilation Clarithromycin to stop spread (after 3w not infective)

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131
Q

Describe the features of viral induced wheeze:

A

Usually >6m with cough and wheeze
Symptoms vary from hour to hour
No symptoms in between episodes

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132
Q

What may be the management for viral induced wheeze?

A

May benefit from inhaled beta-2-agonists

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133
Q

What are some causes of acute wheeze in children?

A

Asthma, viral wheeze, bronchiolitis, atypical pneumonia, foreign body inhalation, anaphylaxis

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134
Q

What are some causes of recurrent/persistent wheeze in children?

A

Asthma, broncho-pulmonary dysplasia, CF,

bronchiectasis, recurrent aspiration, vocal cord dysfunction, structural abnormality

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135
Q

What is the cause of cystic fibrosis?

A

Mutations (F508) in cystic fibrosis transmembrane

conductance regulator gene (CFTR) on chromosome 7, coding a cyclic AMP regulated Na/Cl channel

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136
Q

How are newborns screened for cystic fibrosis?

A

Screened for an abnormally raised immunoreactive trypsinogen and 29 CTFR mutations

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137
Q

List the cut off values for the sweat test for CF:

A

Sweat Cl - >60mmol/L support diagnosis

<40mmol/L is normal and intermediate results are suggestive

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138
Q

How can CF present?

A

Meconium ileus, recurrent pneumonia, failure to thrive, slow growth, steatorrhea

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139
Q

What respiratory organisms typically affect those with CF?

A

S. aureus, H. influenzae, S. pneumonia, pseudomonas aeruginosa

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140
Q

How can respiratory problems in CF be managed?

A

Start physio (3x a day) at diagnosis
Teach parents percussion and postural drainage
Treat infections aggressively

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141
Q

Describe the recommended diet in CF:

A

High calorie, high protein and high fat with Vit A and D

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142
Q

What medications can be given to help GI absorption in CF?

A

Pancrex V/Creon

Omeprazole

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143
Q

What is meconium ileus?

A

Failure to pass stool or vomiting in first 2 days of life

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144
Q

What is the management for meconium ileus?

A

NGT drainage, washout enemas, excision of gut containing most meconium

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145
Q

What are some complications associated with CF?

A

Impaired glucose tolerance, bronchiectasis, cirrhosis,

cholesterol gallstones, male infertility

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146
Q

Name some triggers for asthma:

A

Pollen, house dust mite, fur, exercise, chemicals, smoke, traffic, cold air, NSAIDs, beta blockers

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147
Q

What are some investigations for suspected asthma?

A

Spirometry, peak flow, exhaled NO, exercise testing, skin prick

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148
Q

Describe the step-wise treatment for asthma:

A
  1. PRN salbutamol. If need >3x per week or asthma
    wakes from sleep >1 per week, add step 2.
  2. Add inhaled steroid e.g. beclomethasone
  3. If <5y, add 1 evening dose of montelukast 4mg. If >5y can try inhaled salmeterol (LABA). If symptomatic increase ICS and add montelukast or theophylline
  4. Refer to specialist
  5. Add prednisolone at lowest dose
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149
Q

Describe the treatment for severe asthma:

A 
High flow O2
Salbutamol nebs
Hydrocortisone IV
IV magnesium sulfate 
Aminophylline IV 
ITU if exhausted or needing IV salbutamol
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150
Q

What are the defining features of acute severe asthma?

A

PEFR 33-50%, inability to complete sentences, use of

accessory muscle, tachypnoea, tachycardia

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151
Q

What are the defining features of life-threatening asthma?

A

Resp acidosis, mechanical ventilation. PEFR <33%, sats
<92%, silent chest, cyanosis, poor resp effort,
bradycardia, hypotension, exhaustion

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152
Q

What type of viruses are measles, mumps and rubella?

A

RNA viruses

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153
Q

What are the features of measles infection?

A

Cough, coryza, conjunctivitis, cranky, increased temp, Koplik spots on palate, rash (behind ears then spreads down body)

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154
Q

What are some complications of measles infection?

A

Otitis media, croup, tracheitis, pneumonia

Subacute sclerosing panencephalitis (7-13y later)

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155
Q

How are viral infections such as MMR treated?

A

Ensure adequate nutrition and hydration (NGT if poor feeding)
Continue breastfeeding
Treat any secondary bacterial infections

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156
Q

Which of measles, mumps, rubella and scarlet fever are notifiable diseases?

A

All of them

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157
Q

What are the features of rubella infection?

A

Macular rash (starts on face), suboccipital lymphadenopathy

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158
Q

What are the features of mumps infection?

A

Prodromal malaise, increased temp., painful parotid swelling

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159
Q

What is the causative organism of slapped cheek/fifth disease?

A

Parvovirus B19

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160
Q

What are the features of Parvovirus B19 infection?

A

Malar erythema (slapped cheek), gloves and socks rash, lethargy, fever

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161
Q

What is the causative organism of hand, foot and mouth disease?

A

Coxsackie virus A16

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162
Q

What is the causative organism of roseola infantum?

A

Herpes virus 6

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163
Q

What are the features of roseola infantum?

A

Increased temp. then a maculopapular rash, uvulo-palatoglossal junctional ulcers (Nagayama spots)

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164
Q

What is the cause of scarlet fever?

A

Reaction to erythrogenic toxins produced by Group A haemolytic strep (S. pyogenes)

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165
Q

What are the features of scarlet fever?

A

Fever, malaise, headache, strawberry tongue, fine punctuate erythema on torso sparing palms and soles

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166
Q

What is the treatment for scarlet fever?

A

Pen V for 10 days

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167
Q

What are the complications of scarlet fever?

A

Otitis media, rheumatic fever, glomerulonephritis

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168
Q

What are the features of chickenpox?

A

Crops of skin vesicles often starting on face, scalp or trunk. Rash is more concentrated on torso

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169
Q

When does chickenpox stop becoming infective?

A

Once lesions have scabbed over

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170
Q

Describe the course of a chickenpox infection:

A

fever, rash 2 days later (macule -> papule -> vesicle -> ulcers -> crusting)

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171
Q

What are some dangerous contexts for chickenpox infection?

A

Immunosuppression, CF, severe eczema, neonates

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172
Q

What is the general management for chickenpox?

A

Calamine lotion soothes, trim nails, daily antiseptic

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173
Q

What is the management for chickenpox in dangerous context (e.g. immunosuppression)?

A

Antivaricella-zoster immunoglobulin and acyclovir, started within 7 days of rash

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174
Q

When should heel-prick test (blood spot screening) be performed?

A

5-9 days of life

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175
Q

What is the purpose of heel-prick test (blood spot screening)?
P.S. name at least 5 conditions

A

Screening for: congenital hypothyroidism, CF, sickle cell, PKU, medium chain acyl-CoA dehydrogenase deficiency, maple syrup urine disease, isovaleric
acidaemia, glutaric aciduria type 1, homocystinuria

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176
Q

Describe the newborn examination, including the 4 key areas to examine:

A

Focuses on heart (murmurs), eyes (red reflex – retinoblastoma and cataracts), hips (dislocation) and testes (undescended)
Also birth marks, spinal defects, head circumference,
cleft palate, abdo masses

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177
Q

Describe the newborn hearing test:

A

Otoacoustic emission test

If 2 abnormal tests refer for auditory brainstem response test

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178
Q

What are contraindications to live vaccines?

A

Acute febrile illness is a contraindication to any vaccine

Primary immunodeficiency or on steroids

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179
Q

What conditions are included in the 6 in 1 vaccine?

A

Diphtheria, tetanus, pertussis, polio, haemophilus B, hep B

180
Q

What vaccinations may be given in pregnancy?

A

Pertussis and Flu

181
Q

What vaccinations are given at 2 months?

A 
Infanrix hexa (diphtheria, tetanus, pertussis, polio,
haemophilus B, hep B) + Rotarix (rotavirus) + Bexsero (meningitis B)
182
Q

What vaccinations are given at 3 months?

A

Infanrix hexa (6 in 1) + Rotarix (rotavirus) + Prevenar 13 (pneumococcal)

183
Q

What vaccinations are given at 12 months?

A

Menitorix (H. influenzae with meningitis C) + Bexsero (men B)

184
Q

What vaccinations are given at 13 months?

A

MMR + Prevenar 13 (pneumococcal)

185
Q

What vaccinations are between 3.25-5 years?

A

Repevax (diphtheria, tetanus, pertussis, polio) + MMR

186
Q

What vaccinations are given at 13-18+ years?

A

Revaxis (low dose diphtheria, tetanus, polio) + Gardasil + Menveo (meningococcal ACWY)

187
Q

What vaccinations are given at 4 months?

A

Infanrix hexa (6 in 1) + Prevenar 13 (pneumococcal) + Bexsero (men B)

188
Q

What is the definition of child abuse?

A

Deliberate infliction of harm to a child or failure to prevent harm

189
Q

What is the definition of neglect?

A

Persistent failure to meet a child’s basic physical or psychological needs that is likely to result in serious impairment of child’s health and development

190
Q

What is Munchausen’s by proxy?

A

Parent fabricates alarming symptoms in their child to

gain attention via unnecessary interventions

191
Q

What are the types of child abuse?

A

Physical, sexual, emotional, neglect

192
Q

What are some risk factors for non-accidental injury?

A

Low birth weight, mother <30, unwanted pregnancy, stress, poverty

193
Q

What are some signs/presentations that may make you suspect non-accidental injury?

A

Odd story, incongruent with injuries
Delayed presentation
Unexplained fractures e.g. forearm, posterior ribs from squeezing
Bruises of different ages, not on shins and elbows
Buttock, face injuries, cigarette burns, retinal haemorrhages

194
Q

What investigations may be performed if a child has suspected NAI?

A

Skeletal survey with X-ray

Clotting screen

195
Q

What are the features of shaken baby syndrome?

A

Retinal haemorrhages, subdural haematoma, and encephalopathy

196
Q

What are some key interventions to prevent sudden unexplained infant death?

A

Sleeping supine, preventing overheating and no cigarette exposure

197
Q

What are some features of trisomy 21?

A

Single palmar crease, hypotonia, flat face, protruding tongue, upward slanted palpebral fissures, speckled iris (Brushfield spots), intellectual impairment

198
Q

What are some conditions associated with trisomy 21?

A

Congenital heart disease (AVSD, PDA, VSD), duodenal atresia, hypothyroidism, hearing loss, leukaemia, early onset Alzheimer’s, subfertility, repeated resp. infection

199
Q

What are some features of Turner’s?

A

Short stature, webbed neck, widely spaced nipples, primary amenorrhoea, high arched palate, short 4th metacarpal

200
Q

What are some conditions associated with Turner’s?

A

Bicuspid aortic valve, CoA, hypothyroidism, horseshoe kidney, autoimmune disease e.g. Crohn’s

201
Q

What are some features of Duchenne’s?

A

X-linked, Gowers’ sign, imbalance of lower limb strength, delayed motor milestones, falls

202
Q

What are some investigations performed if Duchenne’s is suspected?

A

Serum creatine kinase, genetics, muscle biopsy

203
Q

What are some features of Fragile X?

A

Learning difficulties, large low set ears, long thin face, macro-orchidism, hypotonia, autism

204
Q

What is the inheritance pattern for achondroplasia?

A

Autosomal dominant

205
Q

What are some features of achondoplasia?

A

Short limbs, frontal bossing, flattened nasal bridge, ‘trident’ hands, lumbar lordosis

206
Q

What are some features of Noonan’s?

A

Webbed neck, widely spaced nipples, short stature, pectus excavatum, low set ears

207
Q

What are some examples of autosomal dominant conditions?

A

Adult polycystic kidney disease, Huntingdon’s chorea, achondroplasia, Ehlers-Danlos, hereditary
spherocytosis, Marfan’s, osteogenesis imperfecta

208
Q

What are some examples of autosomal recessive conditions?

A

CF, beta-thalassaemia, sickle cell, congenital adrenal hyperplasia, homocystinuria, PKU

209
Q

What are some examples of X-linked recessive conditions?

A

Duchenne muscular dystrophy, haemophilia A+B, fragile X

210
Q

What are some examples of X-linked dominant conditions?

A

Alport’s, Rett, vit D resistant rickets

211
Q

What are some causes of childhood obesity?

A 
Fast and processed foods
Lack of exercise
Poor sleep
Deprivation
Steroids and anti-epileptics
Conditions e.g. Cushing's, Prader-Willi
212
Q

What are the consequences of childhood obesity?

A

T2DM, sleep apnoea, orthopaedic problems (SUFE, pains), non-alcoholic fatty liver, atherosclerosis, cancers (breast and bowel), HTN

213
Q

How is a child being overweight, obese or severely obese defined by BMI charts?

A

BMI over 91st centile is overweight, over 98th is obese and over 99.6th is severely obese

214
Q

How should gastroenteritis be managed?

A

Oral rehydration therapy and continue breastfeeding

If poor oral intake, NGT or if severe IV therapy

215
Q

What is the cause of kwashiorkor?

A

Decreased intake of protein and essential AAs

216
Q

What are the features of kwashiorkor?

A

Poor growth, diarrhoea, skin/hair depigmentation, distended abdomen

217
Q

What is the cause of marasmus?

A

Lack of calories and discrepancy between height and weight

218
Q

What are the features of marasmus?

A

Distended abdo, diarrhoea, constipation, infection, low albumin

219
Q

What are some common causes of acute abdominal pain in the child?

A

Gastroenteritis, UTI, viral illness (mesenteric adenitis),

appendicitis, constipation, food allergy

220
Q

What investigations should be done for acute abdominal pain in the child?

A

Urine dip, AXR, US, FBC, CRP, renal imaging

221
Q

What are the features of appendicitis?

A

RLQ pain, anorexia, slight vomiting, polyuria, fever, high pulse

222
Q

How can GORD present in children?

A

Regurg after feeds, apnoea, pneumonia, failure to thrive, anaemia

223
Q

What is the treatment for GORD in children?

A

Reassurance, check positioning during feed, avoidance of overfeeding, antacids after each breast feed.

224
Q

What often precedes mesenteric adenitis?

A

Viral infection

225
Q

What are some causes of hepatomegaly in children?

A

Infectious mononucleosis, CMV, leukaemia, lymphoma, neuroblastoma, galactosemia, sickle cell

226
Q

What is neuroblastoma and where does it commonly arise?

A

Embryonal neoplasm derived from sympathetic neuroblasts

Most commonly arises from the adrenal glands

227
Q

What markers are often raised in neuroblastoma?

A

Urinary excretion of catecholamines are raised (vanillylmandelic and homovanillic acid)

228
Q

How can Coeliac disease present?

A

Diarrhoea, failure to thrive, anaemia, short stature, deceleration of growth

229
Q

What conditions is Coeliac disease associated with?

A

T1DM and hypothyroidism

230
Q

How can diagnosis of Coeliac disease be confirmed?

A

Raised IgA anti-tissue transglutaminase and endomysial antibodies
Confirm by villous atrophy on small bowel biopsy

231
Q

When and how does infantile hypertrophic pyloric stenosis present?

A

3-8 weeks with projectile vomiting after feeds

232
Q

What metabolic abnormalities can occur in hypertrophic pyloric stenosis?

A

Hypochloraemic, hypokalemic metabolic alkalosis

233
Q

How should infantile hypertrophic pyloric stenosis be treated?

A

Ramstedt’s pyloromyotomy/endoscopic surgery

234
Q

What is intussusception?

A

One segment of small bowel telescopes inside another

235
Q

What ages does intussusception usually occur between?

236
Q

How does intussusception present?

A

Episodic intermittent inconsolable crying, drawing legs up ± vomiting and red currant blood PR

237
Q

How is intussuscpetion managed?

A

US with reduction by air enema

If fails, reduction at laparoscopy or laparotomy and resection of necrotic bowel

238
Q

What is phimosis?

A

Foreskin is too tight and doesn’t retract

239
Q

Up to what age is it normal to have non-retractile foreskin?

240
Q

How does testicular torsion present?

A

Severe, sudden onset pain with N+V

241
Q

What ages does testicular torsion commonly affect?

242
Q

What is the management for testicular torsion?

A

Surgical exploration, fix both if torted testis identified

243
Q

How can a UTI present in a child?

A

Dysuria, frequency, sepsis, vomiting, colic, abdominal pain, fever

244
Q

What investigations may be done if a UTI is suspected?

A

Dipstick, urine culture, USS, micturating cystogram

245
Q

What is the treatment for UTI in <3m olds?

A

IV amoxicillin and gentamicin

246
Q

What is the treatment for UTI in those >3m old?

A

Trimethoprim, nitrofurantoin or co-amoxiclav

247
Q

What are some cause of AKI in children?

A 
Toxic drugs (NSAIDs, aminoglycosides, acyclovir, contrast)
Sepsis, dehydration, glomerulonephritis, cardiac surgery, bone marrow transplant
248
Q

What changes in plasma chemistry (electrolytes) may be seen in AKI?

A

Increased potassium, creatinine, urea, phosphate

Decreased calcium, sodium and chloride

249
Q

What are the features of haemolytic uraemic syndrome?

A

Acute haemolytic anaemia, thrombocytopenia, renal failure and endothelial damage to glomerular capillaries

250
Q

What organism is haemolytic uraemic syndrome associated with?

A

Shiga toxin producing E. coli

251
Q

How can acute glomerulonephritis present?

A

Haematuria, oliguria, increased BP, periorbital oedema, fever, loin pain

252
Q

What investigations should be performed if acute glomerulonephritis is suspected?

A

FBC, U+Es, complement (low C3, normal C4), antinuclear factor, anti-DNA, ANCA, blood cultures, MSU, renal US

253
Q

Describe the features of post-streptococcal glomerulonephritis:

A

Presents 7-21 days after a strep infection (pharyngitis, impetigo) with gross haematuria, oedema, HTN, abdo pain, fever

254
Q

How should post-streptococcal glomerulonephritis be treated?

A

Restricting sodium, diuretics, anti-hypertensives, penicillin for 10 days

255
Q

Describe the features of nephrotic syndrome:

A

Oedema, proteinuria, albumin <25g/L ± hypercholesterolemia

256
Q

What are some symptoms of nephrotic syndrome?

A

Insidious onset oedema (starts periorbital), anorexia, GI disturbance, infections, irritability, ascites, oliguria, frothy urine

257
Q

What are some complications of nephrotic syndrome?

A

Pneumococcal peritonitis, increased susceptibility to infection (loss of Ig)

258
Q

How should nephrotic syndrome be managed?

A

Fluid restrict to 800- 1000ml/day

Diuretics if oedematous and no hypovolemia Prednisolone for 4 weeks

259
Q

What are some side effects of steroids in children?

A

Obesity, poor growth, increased BP, diabetes, osteoporosis, avascular necrosis (hip), adrenal suppression

260
Q

What is failure to thrive?

A

Poor weight gain in infancy

Weight affected first then height then head circumference

261
Q

What is the cause of failure to thrive in the majority of cases?

A

Not enough food being offered or taken

262
Q

What are some causes of failure to thrive?

A

Malnutrition, CF, coeliac, cleft palate, GORD, CMPA, congenital heart defects, infection

263
Q

How is short stature defined?

A

Height <3rd centile

264
Q

What are the causes of short stature?

A

Constitutional (80%), neglect, poverty, steroids, genetic

(Turner’s, CF), hypothyroidism, low GH

265
Q

What are some causes of increased height in children?

A

Thyrotoxic, precocious puberty, Marfan’s, homocystinuria

266
Q

What are some causes of increased weight in children?

A

Diet, not enough exercise, hypothyroidism, Cushing’s, Prader-Willi, PCOS

267
Q

Falling below which centile for height means a child should be reviewed by a GP?

268
Q

Falling below which centile for height means a child should be reviewed by a paediatrician?

269
Q

What are some signs of hypothyroidism in children?

A

Prolonged neonatal jaundice, poor feeding, dry skin, inactivity, slow feeding, constipation, bradycardia, poor growth, decreased IQ

270
Q

What is the treatment for hypothyroidism in children?

A

Levothyroxine

271
Q

What are some signs of hyperthyroidism in children?

A

Palpitations, tremor, anxiety and tachycardia

272
Q

What is the treatment for hyperthyroidism in children?

A

Carbimazole or propylthiouracil

273
Q

What is the issue in glycogen storage disorders?

A

Defects in enzymes required for synthesis and degradation of glycogen
Abnormal stores are deposited in liver, muscle, heart or kidney causing organ damage

274
Q

Describe the pathophysiology of phenylketonuria:

A

Mutation of phenylalanine hydroxylase gene (autosomal recessive) leading to absent or reduced activity and accumulation of phenylalanine

275
Q

What are some features of PKU?

A

Fair hair, fits, eczema, musty urine, decreased IQ

276
Q

What is the treatment for PKU?

A

Diet low in phenylalanine

Protein substitute lacking phenylalanine but enriched in tyrosine

277
Q

Describe the pathophysiology of homocystinuria:

A

Deficiency of cystathionine beta-synthase, results in accumulation of homocysteine, oxidized to homocystine

278
Q

What are some features of homocystinuria?

A

Fine fair hair, arachnodactyly, learning difficulties, increased VTE risk, malar rash

279
Q

What is the definition of precocious puberty in girls and boys?

A

Puberty before 8y in girls, before 9y in boys

280
Q

What is the treatment for precocious puberty?

A

Synthetic GnRH analogues suppress secretion of pituitary gonadotropins

281
Q

What ages is the onset of T1DM common at in children?

A

5-7 years and just before onset of puberty

282
Q

How can T1DM present in children?

A

Polyuria, lethargy, polydipsia, weight loss, infections, poor growth, ketosis

283
Q

Hows is T1DM diagnosed?

A

Signs of hyperglycaemia with random blood glucose ≥11.1mmol/L or fasting ≥7mmol/L
Raised venous blood glucose on 2 occasions without
symptoms

284
Q

What is the management for T1DM?

A

Insulin - short and long acting

Advice on diet

285
Q

What are some signs of hypoglycemia?

A

Weakness, hunger, fitness, sweating, abdo pain, vomiting, fits

286
Q

What is maturity onset diabetes of young (MODY)?

A

Autosomal dominant type of non-ketotic diabetes in childhood or young adults
Pancreatic beta cell dysfunction leading to impaired insulin secretion

287
Q

How can diabetic ketoacidosis present?

A

Confusion, vomiting, polyuria, polydipsia, weight loss, abdo pain, dehydration, Kussmaul breathing (deep and rapid), ketotic breath, shock, drowsiness

288
Q

What are the main concerns associated with diabetic ketoacidosis in children?

A

Cerebral oedema, hypokalaemia, aspiration pneumonia

289
Q

How is diabetic ketoacidosis diagnosed?

A

Hyperglycemia (≥11mmol/L), acidosis (pH <7.3 and

bicarbonate <15mmol/L) and ketones in urine and blood

290
Q

What is the management for diabetic ketoacidosis?

A

Correct dehydration with fluids over 48h
IV insulin
Add glucose to fluids when levels start to fall

291
Q

How can cerebral oedema present?

A

Headache, bradycardia, HTN, restlessness, irritability, focal neurology, posturing, RICP, falling consciousness

292
Q

What is the treatment for cerebral oedema?

A

IV mannitol, replace fluids over 72h

293
Q

What are some signs of dehydration?

A

Dry mucous membranes, decreased skin turgor, lethargy, oliguric, weight loss, sunken eyes, increased CRT

294
Q

What are the recommended maintenance fluid requirements based on weight of child?

A

First 10kg: 100ml/kg
Second 10kg: 50ml/kg
Third 10kg+: 20ml/kg

295
Q

When is the peak age for children to get ALL?

296
Q

How does ALL present?

A

Pancytopenia, pallor, infection, bleeding, fatigue, anorexia, fever, bone pain, lymphadenopathy

297
Q

What investigations can be performed if ALL is suspected?

A

FBC, urate, LDH, blood film, marrow biopsy

298
Q

How is ALL treated (broadly)?

A

Chemotherapy including intrathecal therapy

299
Q

What are some complications of ALL?

A

Neutropenic sepsis, hyperuricaemia (TLS), poor growth, other cancers

300
Q

What are some causes of microcytic anaemia in children?

A

IDA or thalassemia

301
Q

What are some causes of macrocytic anaemia in children?

A

Folate def., B12 def. or haemolysis

302
Q

What are some causes of normocytic anaemia in children?

A

Haemolysis or marrow failure

303
Q

What are the main causes of iron deficiency anaemia in children?

A

Dietary causes e.g. poverty, lack of education, coeliac

Bleeding – Meckel’s diverticulum

304
Q

How should iron deficiency anaemia in children be treated?

A

Ferrous fumarate syrup or Sytron

305
Q

What is the inheritance pattern of hereditary spherocytosis?

A

Autosomal dominant

306
Q

What infection alongside hereditary spherocytosis can trigger a severe anaemia?

A

Parvovirus B19

307
Q

What might be the cause of purpura if the child is ill and has low platelets?

A

Meningococcal septicaemia, leukaemia, DIC, haemolytic uraemic syndrome

308
Q

What might be the cause of purpura if the child is ill and has normal platelet count?

A

Viruses (measles), vascultitis

309
Q

What might be the cause of purpura if the child is well and has normal platelet count?

310
Q

What might be the cause of purpura if the child is well and has low platelets?

A

Idiopathic thrombocytopenic purpura

311
Q

Describe Henoch-Schonlein purpura:

A

Acute immune complex mediated vasculitis

Most have a preceding URTI and are often 3-15yrs

312
Q

What are the features of HSP?

A

Purpura, arthritis/arthralgias and abdo pain

313
Q

What is the prognosis for HSP?

A

Most will recover in <2 months

F/u with GP to check for renal involvement

314
Q

What are some complications of HSP?

A

GI bleeds, ileus, haemoptysis, acute renal failure

315
Q

How may idiopathic thrombocytopenic purpura present?

A

Acute bruising, purpura and petechiae

History of recent infection or live vaccine

316
Q

What is the prognosis for idiopathic thrombocytopenic purpura?

A

Most can be managed at home with gradual resolution over 3m

20% become chronic and need to avoid contact sports

317
Q

What are some general signs of a primary antibody deficiency?

A

Frequent infections, bronchiectasis, chronic sinusitis, failure to thrive, hepatosplenomegaly

318
Q

What types of infections are those with IgA def. particularly prone to?

A

Resp and gastro infections

319
Q

Describe the antibody deficiency in common variable immunodeficiency:

A

IgG and IgA levels are low

320
Q

Describe Bruton X-linked agammaglobulinemia and the type of infections that sufferers are most susceptible to:

A

Tyrosine kinase gene mutation causes decreased immunoglobulins and decreased mature B cells, hence increased susceptibility to bacterial (but not viral) infections

321
Q

Describe severe combined immunodeficiency and the type of infections that sufferers are most susceptible to:

A

T-cell dysfunction usually causes combined immunodeficiency as T cells are necessary for B cell differentiation.
Susceptible to all types of bacteria, viral, fungal and protozoal infections

322
Q

How are primary antibody deficiencies managed (broadly)?

A

Treat intercurrent infections promptly - postural physio, bronchodilators and Ab
Immunoglobulin replacement therapy

323
Q

What are some causes of RICP in children?

A

Meningoencephalitis, head injury, subdural/extradural bleeds, hypoxia, ketoacidosis, tumours, thrombosis, Reye’s

324
Q

What are some signs of RICP in children?

A

Irritable, drowsy, headache, diplopia, vomiting, tense fontanelle, decreased level of consciousness
Chronic: papilloedema and hydrocephalus

325
Q

How should RICP be managed?

A

Elevate head, O2, IV mannitol, dex, fluid restrict

326
Q

What are some signs of a brain tumour in a child?

A

Unexplained headache
Progressive weakness, unsteadiness, numbness
Behaviour changes
Growth disturbance

327
Q

Give examples of some brain tumours affecting children:

A

Medulloblastoma, astrocytoma, glioma, meningioma

328
Q

How may meningitis present in children?

A

Irritability, abnormal cry, lethargy, difficulty feeding, fever, seizures, apnoea, bulging fontanelle

329
Q

What are some signs of meningococcal sepsis?

A

Fever, irritability, cold hands/feet, abnormal skin colour,

odd behaviour, rash, DIC, tachycardia, tachypnoea, decreased BP, bulging fontanelle

330
Q

What are meningeal signs that often occur later in meningococcal sepsis?

A

Stiff neck, photophobia, Kernig’s sign (resistance to knee extension with hip flexed), Brudzinski’s sign (hips flex on bending head forward)

331
Q

What does a lumbar puncture aim to obtain?

A

CSF for urgent Gram stain, culture, virology, glucose and protein

332
Q

What drug can be given prior to hospital admission if meningitis is suspected?

333
Q

What treatment should be given to <3m with meningitis?

A

Cefotaxime and amoxicillin

334
Q

What treatment should be given to >3m-18y with meningitis?

A

Ceftriaxone

335
Q

What are some complications following meningitis?

A

Secondary abscesses, subdural effusion, hydrocephalus, ataxia, paralysis, deafness, decreased IQ, epilepsy

336
Q

Describe the appearance, predominant cells, glucose level compared to blood and protein level of normal CSF:

A

Clear, <5 lymphocytes, >2/3rd of blood, 0.2-0.4g/L

337
Q

Describe the appearance, predominant cells, glucose level compared to blood and protein level of CSF in bacterial meningitis:

A

Turbid, polymorphs, <2/3rd of blood, increased

338
Q

Describe the appearance, predominant cells, glucose level compared to blood and protein level of CSF in viral meningitis :

A

Clear, mononuclear, >2/3rd of blood, increased

339
Q

Describe the appearance, predominant cells, glucose level compared to blood and protein level of CSF in tubercular meningitis:

A

Fibrin web, mononuclear, <2/3rd of blood, increased

340
Q

What are the main causative organisms of meningitis in neonates to 3m olds?

A

E. coli, Group B strep, listeria

341
Q

What are the main causative organisms of meningitis in neonates to 1m olds to 6 year olds?

A

N. meningitidis, H. influenzae, S. pneumoniae, TB, viruses

342
Q

What are the different classifications of seizure in epilepsy?

A

Partial (one part of a hemisphere)
Generalised
Complex (consciousness affected)
Simple

343
Q

Give examples of generalised seizure types in children:

A 
Tonic clonic
Absences
Infantile spasms/West syndrome: clusters of head
nodding and arm jerks
Myoclonic
344
Q

What investigations may be performed if epilepsy is suspected?

A

EEG, MRI, CT

345
Q

What is the management for tonic-clonic seizures?

A

Sodium valproate

346
Q

What is the management for absence seizures?

A

Ethosuximide

347
Q

What is the management for myoclonic seizures?

A

Sodium valproate

348
Q

What is the management for infantile spasms?

A

Vigabatrin

349
Q

What is the management for partial seizures?

A

Carbamazepine/lamotrigine

350
Q

What are the features of a febrile convulsion?

A

Single tonic-clonic generalised seizure, lasting <15 min
Occurring as temp rapidly rises in a febrile illness
Child aged 6m-6yrs
No more than 1 attack in 24h

351
Q

How should febrile convulsions be managed?

A

Recovery position
If fit is lasting >5min can give lorazepam
Early anti-pyretic
If seizure lasts >10min, treat at status epilepticus

352
Q

Describe the features of reflex anoxic attacks:

A

Paroxysmal, self-limited brief asystole triggered by pain, fear or anxiety
Child is pale and may have hypotonia, rigidity,
clonic movement, upward eye deviation
Usually in 6m-2yrs

353
Q

What is the management for status epilepticus?

A

Secure airway
After 5 min, give IV lorazepam and repeat after 15 min
IV Phenytoin after 20 min
Intubate and ICU after 40 min

354
Q

What are some side effects of carbamazepine?

A

Rash, decreased platelets, agranulocytosis, aplasia

355
Q

What are some side effects of valproate?

A

Vomiting, increased appetite, drowsiness, decreased platelets, teratogen

356
Q

What are some side effects of ethosuximide?

A

D+V, rash, erythema multiforme, lupus syndromes, agitation, headaches

357
Q

What are some side effects of vigabatrin?

A

Drowsiness, depression, psychosis, amnesia, diplopia, field defects (test every year)

358
Q

How should food refusal by children be managed?

A

Discourage parental over-reaction

Gradual enlarging of tiny portions of attractive food Track growth, weight gain, ferritin and FBC

359
Q

What is pica?

A

Eating things that are not food

360
Q

What are some causes of pica?

A

Iron or other mineral def., OCD

361
Q

How may constipation present in children?

A 
Large hard stool, rabbit dropping stool
Distress/straining
Abdo pain
Overflow/soiling 
Anorexia
362
Q

What are some common causes of constipation in children?

A

Idiopathic, diet, poor fluid or fibre intake, fear (fissure)

363
Q

What are some red flag signs associated with constipation?

A

Constipation from birth or first few weeks
Failure to pass meconium within 48h
Faltering growth
New weakness/abnormal reflexes in legs
Abnormal appearance of anus or skin in sacral/gluteal region
Gross abdominal distension with vomiting

364
Q

What is the general management for constipation in children?

A

Movicol/lactulose (osmotic) then senna (stimulant) Increase fluids and fibre, modify diet, behaviour therapy, physical activity

365
Q

What is encopresis?

A

Repeated passage of solid faeces in the wrong place in those >4yrs
Often due to overflow in constipation

366
Q

How should encopresis be managed?

A

Enemas, extra fibre, stool softeners

Mandatory daily toilet sitting after eating

367
Q

How is enuresis defined in girls and boys?

A

Continued wetting of bed >5y in girls and >6y in boys

368
Q

How should enuresis be managed?

A

Regular toilet use (4-7/day)
Rewards for agreed behaviour (using toilet before bed)
Alarms triggered by urine in bed can help

369
Q

What is a good short term management option for enuresis?

A

Desmopressin

370
Q

At what age do children start to say monosyllables e.g. ba, da?

371
Q

At what age do children start to say two syllables e.g. mama, dada?

372
Q

At what age do you children start to use words appropriate in context and understand single words e.g. no?

373
Q

What are some causes of delayed talking?

A 
FH of delay
Chronic otitis media
Deprivation, poor social interaction, abuse
Global developmental delay
Autism
374
Q

Whta is global neurodevelopmental delay?

A

Delay in all skill areas although may be more pronounced in fine motor, speech and social skills

375
Q

List some causes of global neurodevelopment delay:

A 
Down's 
Fragile X
PKU
Hydrocephalus
TORCH infections
Prematurity leading to IVH
376
Q

What are some causes of delay in walking?

A 
Chronic illness
Global delay
Benign immaturity
Joint hypermobility
DMD and cerebral palsy
377
Q

What is cerebral palsy?

A

Comprises chronic disorders of posture and movement caused by non-progressive CNS lesions sustained before 2yrs

378
Q

What are the main issues in cerebral palsy?

A

Delayed motor development
Evolving CNS signs
Learning disability
Epilepsy

379
Q

What are some signs of cerebral palsy?

A

Weakness, paralysis
Delayed milestones language/speech problems
Seizures
Abnormal gait, abnormal tone in early infancy
Early hand preference (<12m)
Retention of primitive reflexes

380
Q

What are the different classes of cerebral palsy?

A

Spastic - most spastic diplegia or hemiplegia
Dyskinetic (athetoid)
Ataxic
Mixed

381
Q

How can cerebral palsy be managed?

A

Muscle strengthening
Callipers
Botulinum toxin for spasticity
Epidural cord electrostimulation and intrathecal/oral baclofen

382
Q

At what ages are most ADHD diagnoses made?

383
Q

What are the two groups of diagnostic features used in ADHD and how many must a child have to be diagnosed?

A

Inattention
Hyperactivity and impulsivity
6 features

384
Q

What is the initial management for ADHD?

A

Ten-week watch and wait period to observe symptoms

385
Q

What are some secondary care management options for ADHD?

A

Positive parenting and advice on behavioural techniques

Drug therapy

386
Q

What drugs can be given for ADHD and after what age?

A

> 5y
Methylphenidate, lisdexamfetamine, dexamfetamine
Atomoxetine

387
Q

What monitoring is required for ADHD drugs?

A

Baseline ECG and BP

Monitor weight and height every 6 months

388
Q

At what age does autism develop before?

389
Q

What are the 3 core features of autism?

A

Global impairment of language and communication
Impairment of social relationships
Ritualistic and compulsive phenomena

390
Q

What is the management for autism?

A 
Behavioural intervention
School support
Social skills training
Melatonin to help sleep
Parent training
391
Q

What are some conditions associated with autism?

A

Fragile X and Rett’s syndrome

392
Q

What are some signs of impaired reciprocal social interaction characteristic of autism?

A

Unaware of other’s feelings, abnormal response to being hurt, impaired imitation, repetitive play, bad at making friends

393
Q

What are some signs of impaired imagination characteristic of autism?

A

Few facial expressions, avoids mutual gaze, no smiles, no interest in stories, no pretend play, odd speech, difficulty initiating conversation

394
Q

What are some signs of ritualistic and compulsive phenomena characteristic of autism?

A

Stereotyped movements, preoccupation with parts of objects, marked distress over minor changes, insists on following routines in precise details

395
Q

What are some risk factors for developmental dysplasia of hip?

A

Female, breech, FH, firstborn, oligohydramnios, very high BWT

396
Q

What examinations should be performed for developmental dysplasia of hip?

A

USS
Barlow (dislocate femoral head)
Ortolani (relocate dislocated head)

397
Q

What are some management options for developmental dysplasia of hip?

A

Spontaneous stabilisation at 3-6w
Pavlik harness
Surgery

398
Q

What are the main causative organisms of osteomyelitis?

A

S. aureus, pseudomonas, E. coli, strep

399
Q

How can osteomyelitis present?

A

Gradual onset of pain and unwillingness to move Tenderness, warmth, erythema and swelling

400
Q

What is the management for osteomyelitis?

A

Surgery to drain abscess and Abx

401
Q

What are the features of rickets?

A

Vit D def. leading to normal bony tissue with decreased mineral content
Knock-knee, bow leg, features of hypocalcaemia

402
Q

How should rickets be treated?

A

Calcium with Vit D tablets

403
Q

What is the most common cause of hip pain in children?

A

Transient synovitis

404
Q

What are the features of juvenile idiopathic arthritis?

A

<16y, lasts >6 weeks

Pyrexia, salmon pink rash, lymphadenopathy, arthritis, uveitis, weight loss

405
Q

What is Perthes’ disease?

A

Avascular necrosis of the femoral head, specifically the epiphysis

406
Q

Who does Perthes’ disease usually affect?

A

More common at 4-8 years and in boys

407
Q

What is the management for Perthes’ disease?

A

Remove pressure from joint to allow

normal development, use cast to keep head in acetabulum, may need surgery

408
Q

Who does slipped upper femoral epiphysis usually affect?

A

10-15 years, obese males

409
Q

What is Osgood-Schlatter disease?

A

Osteochondrosis characterised by inflammation at the tibial tuberosity due to repeated avulsion of the apophysis where patellar tendon inserts

410
Q

How does allergic rhinitis present?

A

Nasal congestion, sneezing, itchy nose with allergic triggers

411
Q

What is the management for allergic rhinitis?

A

Antihistamine, intranasal steroids, allergen avoidance

412
Q

How should food allergies be investiagted?

A

History, examination, skin prick test, in vitro IgE, oral food challenges

413
Q

What are some common food allergens?

A

Peanut, tree nuts, milk, egg, fish, shellfish, wheat, soya

414
Q

How can adenotonsillar hypertrophy present?

A

Obstructive sleep apnoea

Recurrent middle ear infections

415
Q

How should periobrital cellulitis be investigated?

A

Clinical examination
CT sinus and orbits with contrast
WCC, swabs and cultures

416
Q

How does impetigo present and how should it be treated?

A

Blistering infection of skin, that crusts over

Topical or oral Abx, hydrogen peroxide

417
Q

What are some causes of a maculopapular rash in children?

A

Roseola infantum, slapped cheek, measles, rubella, scarlet fever, Kawasaki, JIA

418
Q

What are some causes of a vesicular, bullous or pustular rash in children?

A

HSV1, chicken pox, hand-foot and mouth, impetigo, SSS syndrome, erythema multiforme

419
Q

What are some causes of a petechial or purpuric rash in children?

A

Enterovirus, meningococcal, HSP, thrombocytopenia,

vasculitis

420
Q

What is the cause of staphylococcal scalded skin syndrome?

A

Release of two exotoxins from toxigenic strains of S. aureus

421
Q

How does staphylococcal scalded skin syndrome present?

A

Fever, irritability, redness of skin, blisters that rupture to give burn appearance

422
Q

How should staphylococcal scalded skin syndrome be managed?

A

IV abx, analgesia, moisturiser

423
Q

How is the mid parental height calculated for use on a growth chart?

A

In males, add 7cm to the mean of parental heights; in females by subtract 7cm
Normally vary by two standard deviations, or
5/10cm each way

424
Q

What are some signs of iron poisoning?

A

N+V, haematemesis, diarrhoea, altered mental state, hypotension

425
Q

What investigations should be done if iron poisoning is suspected?

A

Blood gas, serum iron concentration, U+Es, FBC, glucose, iron levels (4-6h), AXR

426
Q

What is the management for iron poisoning?

A

Gastric lavage/endoscopy to remove tablets
IV fluids and sodium bicarbonate to correct acidosis
Whole bowel irrigation
Chelation with IV desferrioxamine

427
Q

What are some signs of salicylate poisoning?

A

Hearing loss, tachypnoea, resp. alkalosis then metabolic acidosis, N+V, abdominal pain, delirium, seizures

428
Q

What is the management for salicylate poisoning?

A

Fluid resus

Haemodialysis

429
Q

What are some signs of paracetamol overdose?

A

Nausea, pallor, rise in hepatic enzymes (24hr), jaundice, enlarged tender liver, hypoglycaemia, hypotension, encephalopathy, coagulopathy

430
Q

What is the management for paracetamol overdose?

A

Plot plasma paracetamol concentration on nomogram and if above line give acetylcysteine

431
Q

When may intraossesous transfusion be required?

A

Cardiopulmonary arrest, severe burns, prolonged status epilepticus, hypovolemic and septic shock

432
Q

What is the most common site used for intraosseus transfusion?

A

Proximal tibia

433
Q

What are some complications of intraosseous transfusion?

A

Extravasation of fluid, cellulitis, fractures, osteomyelitis, pain

434
Q

What are some contraindications to intraosseous transfusion?

A

Osteoporosis, osteogenesis imperfecta, infection/fracture at site of insertion

435
Q

What doses of drug should be given to a <6m old with anaphlyaxis?

A

Adrenaline 1:1000: 0.15ml
Chlorphenamine: 25mcg/kg
Hydrocortisone: 25mg

436
Q

What doses of drug should be given to a 6m-6y old with anaphlyaxis?

A

Adrenaline 1:1000: 0.15ml
Chlorphenamine: 2.5mg
Hydrocortisone: 50mg

437
Q

What doses of drug should be given to a 6-12y old with anaphlyaxis?

A

Adrenaline 1:1000: 0.3ml
Chlorphenamine: 5mg
Hydrocortisone: 100mg

438
Q

What doses of drug should be given to a >12y old with anaphlyaxis?

A

Adrenaline 1:1000: 0.5ml
Chlorphenamine: 10mg
Hydrocortisone: 200mg

439
Q

How is the dehydration deficit calculated?

A

% dehydration x weight (kg) x 10

440
Q

How quickly should fluids be replaced in hypo/isonatremic dehydration?

441
Q

How quickly should fluids be replaced in hypernatremic dehydration?

442
Q

What is the compression to breath ratio in paediatric life support?

443
Q

What should be given before starting compression in paediatric life support?

A

5 rescue breaths

444
Q

How should chest compressions be performed in an infant?

A

Using two fingers

445
Q

How should chest compressions be performed in a young child?

A

Using heel of one hand

446
Q

How should choking in an infant be managed?

A

Remove any obvious obstructions
5 back blows between scapula
5 chest thrusts
Repeat

447
Q

How should choking in a child >1y old be managed?

A

Remove any obvious obstructions
5 back blows between scapula
5 abdominal thrusts
Repeat

Paeds (2 decks)

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